Covering the World of Communication Sciences and Disorders

News in Brief: October 2013

Birth Experience Linked With Autism

Researchers searching for the causes of autism beyond
genetics have identified another possible influence—whether or not the child's mother underwent procedures to induce or speed up labor.

Health care providers induce or augment labor to help
mothers who have health conditions that could be detrimental to them or their
child.

According to a study published in the journal JAMA Pediatrics, children—particularly males—born to mothers who
were induced and augmented, induced only, or augmented only experienced
increased odds of autism compared with children born to mothers who received
neither labor induction nor augmentation. Researchers controlled for a variety
of factors, including socioeconomic status, maternal health, pregnancy-related
events and conditions, and birth year.

Males born in deliveries in which labor was both induced and
augmented were 35 percent more likely to have autism than those whose mother
did not have either of these treatments. For induction alone, risk was elevated
18 percent, and for augmentation alone, risk went up 15 percent.

The risk to females was not significantly elevated when
labor was both induced and augmented, or induced alone. The likelihood of
autism went up 21 percent with augmentation alone.

The study also found support for other previously
established autism risk factors: Older maternal age (a 30 percent higher risk),
being first born (21 percent higher), and the mother's gestational diabetes (24 percent).

The investigation, which examined the birth and education
records of more than 625,000 children from North Carolina, does not indicate
that labor-related treatments cause autism. And although researchers had
information on the demographics of both parents, the mother's medical history and age at pregnancy, and infant health, they did not have other important information, such as paternal age, maternal medications or the severity of the child's autism spectrum disorder.

Feds Target Providers Who Stop Therapy Just Under the Threshold

Outpatient therapy providers who discharged Medicare
patients just before the patients reached the $3,700 threshold that triggers
automatic medical review are receiving letters asking for additional
documentation of those services.

A supplemental review contractor for the Centers for
Medicare and Medicaid Services will use the additional documentation to
determine the medical necessity for the services.

The claims review period referenced in the CMS letters is
October 2012 through March 2013. During this period—the initial period of
manual medical review—providers were allowed to request pre-approval of
services beyond the threshold by sending CMS documentation of medical need. If
a provider did not seek prior approval, the claims were subject to post-payment
manual medical review.

Although the nature of the review was not specified,
providers who stopped therapy at or near the cap, then resumed during a new
benefit period, are subject to the medical necessity review. The review likely
targets providers who believed that stopping treatment and waiting to begin
again in a new benefit period was saving the beneficiary money—the
out-of-pocket expense of treatment beyond the threshold—and shifting the costs
back to Medicare.

Two students with hearing impairments will get a second
chance to show that their California school districts violated Title II of the
Americans With Disabilities Act by denying their requests for word-for-word
transcription service in the classroom. The 9th U.S. District Court of Appeals
reversed two district courts' judgments, saying that the school districts' compliance with the Individual With Disabilities Act did not necessarily demonstrate compliance with Title II of the ADA [PDF].

The plaintiffs, high school students with hearing impairment
who received special education services under IDEA, alleged that their school
districts had an obligation under Title II of the ADA to provide them with a
word-for-word transcription service. The district court reasoned that a valid
individualized education program under IDEA satisfies a Rehabilitation Act
Section 504 regulation requiring schools to offer children with disabilities a
free, appropriate public education; therefore, because Title II and Section 504
are substantially similar statutes, the IEP also satisfies Title II.

The appeals court rejected that reasoning, indicating that
IDEA compliance does not automatically satisfy Section 504, and that ADA
requirements regarding students with hearing impairment are different than
those imposed by IDEA. The panel reversed the grants of summary judgment on the
ADA claims in both cases and remanded both cases for further proceedings.

Clinicians looking for help making evidence-based clinical
decisions can turn to speechBITE, an evidence-based
practice initiative of Speech Pathology Australia and the University of Sydney.

speechBITE (the Speech Pathology Database for Best
Interventions and Treatment Efficacy) is a free, searchable online database of
peer-reviewed published treatment research for the entire scope of
speech-language pathology. speechBITE provides the citations and, where
possible, the abstracts for these references.

Studies on this database include systematic reviews,
randomized controlled trials, non-randomized controlled trials, case series and
single-case experimental design. Methodological ratings allow users to discern
the scientific quality of each research study. To be included, studies must be
published in a peer-reviewed journal, include an intervention relevant to
speech-language treatment, include participants with (or at risk of) a
communication and/or swallowing disorder, and provide empirical data on
treatment efficacy. Currently, speechBITE has more than 3,700 references across
all levels of evidence, with new references added regularly.

speechBITE will soon upgrade its site with a new design,
layout and information; upgraded search functions; and new sources of evidence,
including clinical practice guidelines. The launch of the new site will take
place at the 2013 ASHA Convention in November.